The complaint of expensive medical care has continued for several years, and recently, there is a growing trend, at the same time, the competent authorities want to make a heavy punch, as an important initiative of medical reform, starting from the separation of medicine within the hospital, launched a campaign to solve the remediation of expensive medical care. However, the expensive to see a doctor is a performance, according to the concept of medicine, he is a disease, what led to the expensive to see a doctor (cause)? How does it arise (pathological process)? What is the reasonable treatment plan? How effective is the treatment? What are the adverse effects? Carefully analyzed, the causes are diverse and the pathological processes are complex. This article attempts to analyze the causes of “expensive medical care”. Since the beginning of history, there have been records of people giving up treatment and losing their lives because they could not afford to see a doctor or the price of medicine was too high to bear. This disease has evolved and mutated with the industrial revolution, and has become a global pandemic, a difficult disease with no cure. Politicians, scientists, and civil society groups around the world have been working on a cure, sacrificing many lives, but no breakthroughs have been made, and accusations between groups continue to occur, intensifying. In the 1990s, the disease broke out in our country and spread to the whole country. The causes and pathogenesis of expensive medical care 1, genetics: Medicine is a discipline related to the health of life. As people’s pursuit of health increases and the value of life is valued, the demand for a medical health protection system continues to be urgent. In ancient times, doctors of internal medicine were mostly ancestral pharmacists, and surgeons were barbers, although they were classified as “craftsmen”, but few people bargained for medical care, and stories of losing their families due to illness were common. Nowadays, people who are engaged in the medical profession have the longest years of higher education and training, and have inherited the mysterious and noble characteristics of the profession, so priceless lives are used to looking for high-priced services. 2. Factors of medical institutions: Over-examination: Medical science continues to advance, and large hospitals have purchased a large number of advanced medical equipment. Unlike in the past, doctors take physical examinations such as looking, smelling and cutting as the main means of seeing patients, supplemented by three major routine laboratory tests, and at most a chest X-ray, at a very low cost. Nowadays, doctors rely on advanced medical equipment in their practice, so she underwent an MRI examination, which showed “avulsion fracture of the right humerus”. It is customary to use MRI, which is tens of times more expensive, to diagnose diseases that could have been diagnosed using ordinary X-rays, increasing the patient’s burden. In the United States, doctors often prescribe “whole-body CT scan” for patients to try to exclude tumors, which not only wastes medical resources, but also exposes the examinees to a large number of rays, increasing the risk of cancer, a phenomenon that is also on the rise in China. Annual mammography for women under 50 years of age has not significantly improved the diagnosis and treatment rate of early breast cancer and has seriously increased the medical burden. The large number of false-positive rates adds to the emotional burden of patients. Another driver of over-examination is the “reversal of evidence” in medical malpractice evaluation. With the long-standing tension between doctors and patients and the decrease in trust between doctors and patients, doctors are no longer able to follow medical protocols and their personal best judgment in making diagnoses, leaving “no-fault” evidence as much as possible with advanced equipment, recording comprehensive examination reports, and winning medical lawsuits that may arise in the future. In the past, the use of medical equipment was called ancillary testing, but today, the physical examination of the patient by the physician has taken a back seat to ancillary status. Overtreatment People are often superstitious about new treatments and have good hopes for newly invented drugs and medical devices. In our neighborhood, we often see that advanced cancer patients, whose tumors have metastasized extensively, enter the end stage of life. At the request of the patient’s family, doctors kindly use the most expensive chemotherapy drugs, biological agents and radiotherapy programs for the patient, and hundreds of thousands of RMB are smashed down, which does not save the patient’s life. A new drug for the treatment of tumors, as long as it can show to extend the life of cancer patients from two months to four months, that is, to achieve the miraculous efficacy, p-value shows a significant difference, the drug regulatory authority after the risk-benefit assessment (risk-benefit), approved the drug to market. This “major breakthrough” began to be used clinically under the promotion of the manufacturer and the media. The miracle of a course of treatment for hundreds of thousands of dollars is the extension of the patient’s life by a few months, resulting in a concentrated waste of medical resources and a huge debt after the patient’s death. At the same time, those few months of life are spent in a hospital bed, with no quality of life at all. Since only the risk-benefit ratio of treatment means is valued, and the cost-effectiveness is ignored, and the concept of pharmacoeconomics is not available, the pursuit of new and expensive treatment methods is the direct driver of “expensive medical care”. Unscientific use of drugs In the field of treatment of a disease, there was a combination of non-steroidal anti-inflammatory drugs unreasonable treatment plan, today there is still the use of expensive biological agents regardless of the severity of the disease, the length of the disease and the prognosis, the economy can afford to inject one, the chronic disease can not be cured, sowing the seeds of “expensive medical care”. New drugs, like high-tech medical instruments, require long time and high investment in research and development, resulting in their relatively high prices. The authorities of each country have conducted pharmacoeconomic evaluations of the use of new drugs and have specified the principles of medical reimbursement. Corresponding medical professional societies have summarized and analyzed the evidence-based medical literature and assigned medication guidelines based on risk-benefit ratios. However, the individualized differences in patients and the variability and complexity of the clinical presentation and progression of the disease make it impossible to adapt the treatment guidelines perfectly to clinical practice, and physicians must combine their own experience to develop treatment plans. However, some physicians do not evaluate patients scientifically and rely only on their feelings, pursuing new drug applications and irrational compounding, resulting in drug abuse, directly increasing medical expenses and causing patient harm and increasing indirect burden by causing adverse reactions. Scientific ignorance Medical science is advancing and the understanding of diseases is deepening, but we humans still have a superficial understanding of our own organism and diseases. We are not yet in control of the trajectory of our lives. In the field of treatment, there is a cycle of “trial and error” (trialanderror) blindness, which causes confusion to patients and waste of resources. The author had a high school classmate who unfortunately suffered from colon cancer. The surgery revealed that the tumor was one centimeter in diameter and did not break through the pulpy muscle layer, and after successful tumor removal, four lymph nodes were biopsied as negative. After the surgery, she was faced with the choice of follow-up treatment. After consulting three famous doctors, there were three different opinions, one was that chemotherapy or radiotherapy was not needed because the tumor was early and did not metastasize; another opinion was that chemotherapy and radiotherapy were needed, and the guiding principle was to biopsy 11 lymph nodes, while the surgery only did 4 lymph node biopsies, those 7 should be assumed to have tumor metastasis; the third suggestion was that regular chemotherapy was not needed, but a little chemotherapy drug must be eaten. A little chemotherapy drug. Three different opinions made the patient lose his direction. Finally, according to the family’s opinion, it is better to believe it and not to leave regrets, and gritted his teeth and went on chemotherapy, spending hundreds of thousands of dollars. Because science can not show the way, only by feeling. 3, commercial promotion The biggest expense of drug and medical device manufacturers is clinical promotion. Pharmaceutical companies often through academic and economic means, to promote clinicians to prescribe drugs. Some companies take advantage of the unreasonable low wages of China’s doctors, to illegal drug rebates, tempting doctors, some clinical efficacy of the drug abuse is not clear, increasing the economic burden on patients. Some other pharmaceutical companies have evolved into tourism companies, seducing doctors for the purpose of selling drugs, and after playing all over the great country, they have started to advance internationally, and have now broken out of Asia and marched to the Middle East. This kind of commercial tourism, which has no academic value and is aimed at promoting drugs, is banned by all developed and developing countries, but this kind of marketing model is flourishing in our country, without any scruples and without any obstacles. Even individual multinational pharmaceutical companies, which are law-abiding in their own countries, are using business models that are “in line with Chinese conditions” to corrupt our doctors like crazy. It is not difficult to imagine that individual doctors, in return for the commercial investment of pharmaceutical companies, use more medical devices and prescribe more drugs. 4. Patients and customs The unbalanced economic development in China is accompanied by a great disparity in the level of medical care. Patients believe in big cities and hospitals and travel long distances to provincial cities and even municipalities to see a doctor, whether it is necessary or not, often including travel and accommodation costs in the total cost of the visit. At the same time, relatives accompanying the doctor’s visit are not hesitant to add their lost wages and other expenses to the medical costs, making the feeling of expensive medical care even more intense. Patients’ demands In outpatient clinics, these words are not unfamiliar: “Doctor, prescribe me some good medicine,” and in wards, such requests are often heard: “Doctor, use the best treatment for my child,” When people lose their health, money is no longer the first concern. When people lose their health, money is no longer the first concern, and it is not uncommon to give up things outside the body for the sake of life. Chinese traditions and customs regard it as treacherous not to support a loved one who is ill, forcing relatives and friends to lend a helping hand to the patient at the critical moment, to give financial support, to look for the most famous hospitals and specialists, and sometimes to inquire from referrals and patients how much red envelope should be given. In our country, the hearts of patients and their families are not secure if red envelopes are not given before surgery. But when the disease is in remission or the patient passes away, families often feel great financial pressure, or even turn against each other because they cannot afford to pay their debts, and count this huge amount of spending (including red envelopes) on the account of expensive medical care. The aunt of the same colleague, when diagnosed with “humeral avulsion fracture”, searched around for famous doctors, and through referrals and online inquiries, made a list of names, starting with the top ones, and mobilized the whole family. My colleague found the top doctor on the list through a famous medical journalist, and found out that the doctor who attended to Liu Xiang specialized in sports medicine and was away on a business trip, so he moved on to a major hospital in another major city. It was a simple orthopedic surgery, which was repeatedly delayed, and the condition became complicated, and the medical and non-medical expenses increased greatly, meanwhile, the lament of “it is really difficult to see a doctor” was incessant. 5, the pitfalls of fake and inferior drugs China has a history of 4,000 years, the ancients have left us a lot of valuable wealth of traditional medicine and therapy, but also mixed with a lot of dross. Some unscrupulous businessmen and medical practitioners, under the banner of “ancestral secret recipes”, “saving traditional treasures” and “protecting traditional Chinese medicine”, have been pushing ineffective prescriptions to patients, taking advantage of the danger of others to make money. The company’s main goal is to make money. At the same time, unscrupulous people use modern technology to mix western drugs (e.g., glucocorticoids) into traditional Chinese medicine, which poses a great safety risk. Patients often “voluntarily” spend a lot of money to buy fake drugs under the encouragement of media advertisements, relatives and friends, and patients. And this account is considered to be the cost of medical care, adding to the “expensive” feeling of medical care. 6, once to see a doctor without money After the founding of New China, China has the least medical resources, the establishment of barefoot doctors, communal health centers, county hospitals, central hospitals, provincial and teaching hospitals as the main line of the hierarchical medical security system, covering the whole country. At that time to see a doctor do not pay, such a concept and habits have been continued to the present day, see a doctor to spend money, it feels like an extra expense. 7, outpatient registration fee and ward bed charges The outpatient registration fee and ward bed charges of our hospitals are surprisingly low, the admission fee for seeing a doctor is lower than that for watching a movie, and the charge for a hospital bed is lower than that of a guest house. However, the equipment and staffing of hospitals are much more complicated and costly than the former. The price of drugs also varies, with some of them being surprisingly low. In the price of all the production materials, only the price of drugs continue to fall, resulting in the same dose of large infusion than Coke and supermarket mineral water is cheaper, some pharmaceutical companies use their own water purification system to produce mineral water, its profits exceed the production of intravenous infusion. State input and bear less China’s national disposable fiscal revenue of 24% of GDP, plus large national savings of 10% of GDP capital income, disposable wealth to 34% of GDP, the highest in the world. Our health care investment has not been published and should be 3% of GDP, among the lowest in the world. The government health care investment in the European Community countries and Canada is 8% of GDP, while the medical consumption in the U.S. is 16% of GDP. 100 years ago, the German Emperor implemented universal health insurance in order to enlist the occupying power, and the UK and Canada also implemented a national health care coverage system with state agencies assessing and enforcing the principle of rational treatment, severely punishing drug abuse, and bargaining with pharmaceutical companies. In the last 30 years, China has gradually abolished publicly funded health care with labor insurance as the main line, rural cooperative health care and barefoot doctors have died out, and witchcraft is rampant in the countryside, pushing the burden of health care on businesses and individuals and allowing hospitals to make their own money to survive. In the United States, where Medicare is at its worst, the 40 million people without health insurance have to wait until their condition worsens and go to the emergency room. Because of the law, emergency rooms cannot turn away the seriously ill and must provide free emergency care for patients, with the state footing the bill. And in our country, there are often reports of seriously ill patients being turned away from the emergency room. 8. Inequality among the people of the country When some people go to the doctor without money, the state pays the bill, and some people need to pay part, or even all, of their own medical costs, forming the same citizens of the Republic, enjoy different treatment, the latter will be compared to the former, even if they do not pay much will be too expensive. Some patients who are over 100 years old have been in coma for several years and have blown out several ventilators just because they are senior retired cadres, and the expensive and meaningless treatment is continuing, wasting a lot of human, financial and space resources. The unequal and unreasonable distribution of medical resources has resulted in the lack of guaranteed basic medical care for the poor people and the barbaric occupation of medical resources by individual powerful people. Therefore, in order to reform the medical system and solve the problem of expensive medical care, we must not judge the disease in a “blind man’s eyes” way and adopt an allopathic approach of “treating the head when it hurts and treating the foot when it hurts”, but must implement a comprehensive treatment to address the causes of the disease, and in the process of treatment In the process of treatment, we should constantly adjust the “treatment plan” according to the condition in order to achieve the best “treatment” effect and avoid “adverse reactions”.